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Indian Pediatr 2011;48: 311-314 |
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Food Security and Anthropometric Failure Among
Tribal Children in Bankura, West Bengal |
DK Mukhopadhyay and AB Biswas
From the Department of Community Medicine, BS Medical
College, Bankura, West Bengal.
Correspondence to: Dipta Kanti Mukhopadhyay, Lokepur,
Near NCC Office, Bankura 722 02, West Bengal, India.
Email: [email protected]
Received: April 08, 2010;
Initial review: May 3, 2010;
Accepted: June 28, 2010.
Published online. 2010 November 30.
PII: 097475591000297-2
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Abstract
We conducted a cross-sectional study among 188 tribal
children aged 6-59 months using two-stage sampling in Bankura-I Block of
Bankura district, West Bengal, India, to assess their nutritional status
and its relation with household food security. Weight and height/length
were measured and analyzed as per new WHO Growth Standards. Mothers of
the study children were interviewed to obtain relevant information.
Prevalence of Composite Index of Anthropometric Failure was 69.1% and
multiple anthropometric failures were more likely among tribal children
aged 24-59 months with irregular utilization of supplementary nutrition
and from households with severe grades of food security.
Key words: Anthropometric failure, Children, Household food
security, India, Tribal.
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R esearch evidence from developing
countries shows that household food insecurity is closely related to
children’s undernutrition [1,2]. In India, numerous nutritional and social
assistance programs are operating with the objectives to ensure food
security and reduce undernutrition, especially among vulnerable population
like under-fives with special focus on scheduled tribes. Nationwide survey
showed definite improvement in nutritional profile of Indian children,
though the picture is still gloomy [3,4]. However, the nutritional status
of tribal children by any indices of its measure is worse than other
children [4].
An aggregate indicator like Composite Index of
Anthropometric Failure (CIAF) might be used to depict a comprehensive
picture of undernutrition instead of conventional indices e.g. stunting,
wasting and underweight [5,6]. Household food security along with other
socio-demographic factors and utilization status of nutritional programs
need to be studied to get a clearer picture of child undernutrition. We
conducted this study to find out the nutritional status of tribal children
and its relation with household food security and other socio-demographic
variables in West Bengal.
Methods
A community-based, cross-sectional study was undertaken
among tribal children aged 6-59 months of Bankura-I Community Development
Block in the month of August-September 2009. As per available data on
prevalence of CIAF among pre-school children in West Bengal [7], with a
95% confidence level, 15% relative precision, design effect of 2 and 5%
non-response rate, the sample size calculated was 188. Out of 25 villages
in Bankura-I CD block with tribals comprising 25% of total population or
more, 50% village i.e. 13 villages were selected randomly. A total of 15
households with study children were selected randomly through house to
house visits. From each selected household, the youngest child was
selected. In case of non-availability of required number of children, the
nearest village was surveyed.
After obtaining informed consent, the mother of the
child was interviewed with a pilot-tested, semi-structured questionnaire
regarding age and sex of the child, duration of mothers’ schooling,
employment status of mother and utilization of Supplementary Nutrition
Program (SNP) under Integrated Child Development Scheme (ICDS) by the
child.
Food security status of the household was assessed
using Household Food Security Scale (HFSS) and households were classified
as having high/ marginal food security, low food security and very low
food security based on raw scores [8]. Household food security scale,
developed by the United States Department of Agriculture was translated
and back translated for validation in Bengali. The harmonized Bengali
version was pilot-tested and found valid (Kappa for each item > 0.84),
internally consistent (Cronbach’s alpha=0.82) and uni-dimensional.
Weight and height of the child was measured as per
guideline of World Health Organization [9]. The age of the child was
ascertained from the available records and if not available, by local
calendar method.
The study was cleared by Institutional Ethics
Committee, BS Medical College, Bankura.
The height/length for age (HAZ/ LAZ), weight for age (WAZ)
and weight for height/length (WHZ/ WLZ) were calculated with the help of
WHO-Anthro-2005 software [10]. Descriptive statistics, chi-square for
trend and binary logistic regression were done with the help of SPSS:
version 15.
Results
Final analysis was done with 188 children as 7
questionnaires were incomplete. Out of them, 53.7% were females, 9.6% were
in age group of 6-11 months, 22.3% belonged to 12-23 months and rest
belonged to 24-59 months. About one third (37.2%) mothers were illiterate
and 23.9% were wage earners. 43.6% children utilized supplementary
nutrition regularly ( ³4
times/week).
Among study children, prevalence of stunting, wasting,
underweight were 50.0%, 20.2%, 53.1% and the corresponding severe grades
were 20.2%, 4.8%, 19.7%, respectively. Table I shows six
subgroups of undernourished children as per CIAF with 23.4% having single
anthropometric failure (Group B, F and Y) and 45.7% had multiple
anthropometric failure (Group C, D and E). In total 69.1% of tribal
children had some form of anthropometric failures.
TABLE I
Subgroups of Anthropometric Failure Among Tribal Children Aged 6-59 Months (n=188)
Subgroups |
No. (%) |
A (No failure) |
58 (30.9) |
B (Wasting only) |
6 (3.2) |
C (Wasting and underweight) |
16 (8.5) |
D (wasting, stunting and underweight) |
16 (8.5) |
E (Stunting and underweight) |
54 (28.7) |
F (Stunting only) |
24 (12.8) |
Y (Underweight only) |
14 (7.4) |
It was observed that 88 (46.8%) of the surveyed
household had high/ marginal food security, 54 (28.7%) had low food
security and 46 (24.5%) were very low food secure. Table II
shows that severe grades of undernourishment were more prevalent in
households with lower grades of food security.
TABLE II
Association Between Different Grades of Household Food Security and Anthropometric Indices (n=188)
Indices |
Household
food security status |
P value |
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High/marginal (n = 88) |
Low (n = 54) |
Very Low (n = 46) |
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Stunting |
22 (25.0) |
16 (29.6) |
18 (39.1) |
<0.001 |
Severe stunting |
10 (11.4) |
13 (24.1) |
15 (32.6) |
|
Wasting |
7 (8.0) |
10 (18.5) |
12 (26.1) |
<0.001 |
Severe wasting |
2 (2.3) |
2 (3.7) |
5 (10.9) |
|
Underweight |
19 (21.6) |
20 (37.0) |
24 (52.2) |
<0.001 |
Severe underweight |
8 (9.1) |
14 (25.9) |
15 (32.6) |
|
Single failure |
21 (47.7) |
15 (34.1) |
8 (18.2) |
<0.001 |
Multiple failures |
26 (30.2) |
27 (31.4) |
33 (38.4) |
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* including the children with no failure in the respective groups.
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In binary logistic regression, it was found that
multiple anthropometric failures were more likely in children living in
low [AOR=5.48 (2.24-13.43)] and very low food secure households [AOR=14.19
(5.14-39.22)]. Similarly, irregular utilization (<4 times/week) of
supplementary nutrition [AOR=3.25 (1.46-7.27)] and age group of 24-59
months [AOR=3.26 (1.26-8.47)] were more likely to be associated with
multiple failures.
Discussion
The present study showed that around two thirds
children were undernourished similar to previous reports [6,7,11].
The findings of widespread prevalence of undernutrition among tribal
children in India were also corroborated in this study [12,13].
The present study revealed that there was a
dose-response relationship between multiple anthropometric failure and
grades of food security as shown in other resource-constrained areas
[1,2,14]. Higher prevalence of multiple failures in older age group could
be explained by inadequacy of food, as previously reported in Bangladesh
[1]. The findings of the present study further emphasized that regular
utilization of supplementary nutrition was a protective factor against
undernutrition.
Analysis in earlier studies showed that children with
multiple anthropometric failures were more likely to experience ill-health
and at more risk of dying than those having single anthropometric failure
[6,7]. Present study showed that taking severe underweight as the sole
criterion for prioritization in SNP under ICDS missed almost 25% children
with multiple anthropometric failures without having severe underweight
(45.7% vs 19.7%), which was corroborated by other researchers [7,11]. So,
SNP under ICDS, set to ameliorate the effects of low household food
security, should focus attention to all children from resource poor
households rather than depend solely on the finding of severe underweight
of the children.
Acknowledgment:The authors gratefully acknowledge
Dr Sujishnu Mukhopadhyay, Assistant Professor, Community Medicine, Burdwan
Medical College, Burdwan and Dr Ansuman Roy, Assistant Professor, Anatomy,
Calcutta National Medical College, Kolkata for their review and valuable
comment.
Contributors: DKM conceived and designed the paper,
collected data, analyzed and interpreted them and drafted the article. He
will act as a guarantor of the article. ABB helped in designing of paper,
interpretation of analyzed data and critically reviewed the article for
important intellectual content. Both approved the final version.
Funding: None.
Competing interests: None stated.
What This Study Adds?
• In the tribal population in Bankura, West Bengal, status of
household food security had a significant relationship with multiple
anthropometric failures. |
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